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Robbins Pathology GI (Chptr 16,17,18,19) > Chapter 17-Esophagus > Flashcards

Chapter 17-Esophagus Flashcards

1
Q

What is the embryological derivation of the esophagus

A

Cranial portion of the forget

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2
Q

What is nutcracker esophagus

A

High amplitude contraction of the distal esophagus due to the loss of normal coordination of the inner circular layer and outer longitudinal smooth muscle contraction

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3
Q

What is diffuse esophageal spasm

A

Repetitive, simultaneous contractions of the distal esophageal smooth muscle

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4
Q

What is the cause of lower esophageal sphincter dysfunction

A

-high resting pressure of incomplete relaxation

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5
Q

What can esophageal dysmotility result in

A

Development of small diverticula (epiphrenchic)right above the lower esophageal sphincter

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6
Q

What is the cause of Zenker diverticulum

A

Impaired relaxation and spasm of the cricopharyngeus after swallowing, which results in increased pressure within the distal pharynx

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7
Q

What is another name for Zenker diverticulum

A

Pharyngoesophageal diverticulum

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8
Q

Where do Zenker diverticulum develop

A

-Above the upper esophageal sphincter in the pharynx

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9
Q

What is the age group commonly to have Zenker diverticulum

A

Over 50

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10
Q

What is the cause of benign esophageal stenosis

A

Narrowing of the lumen caused by fibrous thickening of the submucosa due to atrophy of the muscularis propia due to GERD, irradiation

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11
Q

What are the physical side effects seen in patients with benign esophageal stenosis

A

Usually maintain the appetitive and weight

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12
Q

What are esophageal mucosal webs

A

Ledge like protrusions of mucosa and are composed of fibrovascular connective tissue overlying epithelium

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13
Q

What conditions are associated with esophageal mucosal webs

A

GERD, chronic graft versus host, blistering skin diseases

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14
Q

What conditions will accompany esophageal mucosal webs

A
  • Iron deficiency Anemia
  • Glossitis
  • Cheilosis
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15
Q

What is the name of the condition that has esophageal webs along with the anemia

A

Paterson Brown Kelly or PLummer-Vinson syndrome

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16
Q

What is the main symptom of esophageal webs

A

Nonprogresive dysphagia with incomplete chewed food

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17
Q

What are Schatzki rings

A

Similar to Webs but are thicker and include mucosa, submucosa, and hypertropic muscularis propria

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18
Q

What is the location and make up of A rings

A

Distal esophagus, above the gastroesophageal junction, and contain squamous mucosa

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19
Q

What are the location and make up of B rings

A

Located at the squamocolumnar junction of the lower esophagus and contain gastric cardia-type mucosa

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20
Q

What is the triad that is characteristic of alchalasia

A
  • Incomplete LES relaxation
  • Increased LES tone
  • aperistalsis of the esophagus
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21
Q

What are the symptoms of achalasia

A
  • Difficulty swallowing both liquids and solids
  • Difficulty burping
  • chest pain
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22
Q

What is the cause of primary alchalasia

A

Distal esophageal inhibatory neurons, aka ganglion degeneration
-can be of the extraesophageal vagus nerve or the dorsal motor nucleus of the vagus

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23
Q

What are some causes of achalasia like diseases

A
  • Diabeteic autonomic neuropathy
  • malignancy or amyloidosis
  • downsyndrome
  • Allgrove syndrome (triple A)
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24
Q

What is algrove syndome aka triple A syndrome

A

Autosomal recessive

  • Alchalasia
  • Alacrima
  • adrenocorticotripic hormone resistant adrenal insufficiency
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25
Q

What are Mallory Weiss tears associated with

A

Vomiting secondary to vomiting, especially with alcohol toxicity

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26
Q

What are the symptoms of Boerhaave syndrome

A

Causes mediastinitis
Severe chest pain, tachycardia, shock, and present as a MI
-Can also be causing vomiting of blood/hematemsis due to esophageal perforation.

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27
Q

What is pill induced esophagitis

A

Pill is taken, but dissolves in the esophagus rather than making it to the stomach

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28
Q

What are esophagus infection in healthy individuals caused by

A

HSV, but is very rare

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29
Q

What are the histological and morphological findings of herpes virus in the esophagus

A

Punched out ulcers

Nuclear viral inclusions within the rim of degeneration

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30
Q

What are the histological and morphological findings of CMV in the esophagus

A

Shallow ulcers with nuclear and cytoplasmic inclusions within the capillary endothelium and stromal cells

31
Q

What are the some of the factors that can increase the chances of GERD

A 
Alcohol 
Tabacco
Obesity 
CNS depressants
Pregnancy 
Hiatal herniation
32
Q

Which population of patients is GERD most common

A

Older than 40

33
Q

What is the taste in patients with GERD

A

Tasting of sour tasting gastric contents

34
Q

What are the treatments for patients with GERD

A

Proton pump inhibators

35
Q

What is a condition that resembles GERD and what is it characterized by

A

Hiatal hernias cause similar symptoms, but are caused by speration of the diaphragmatic crura and protrusion of the stomach into the thorax

36
Q

What is the characteristic finding in eosinophilia esophagus

A

Large number of intraepithelial eisinophils superficially

37
Q

What are the symptoms that helps to differentiate GERD from eiosinphilic esophagitis

A
  • Increased eiosinophils
  • No acid reflex
  • High doses of PPI does not work
38
Q

What are the conditions that are associated with eosinophilia esophagitis

A

Atopic dermatitis
Allergic rhinitis
Asthma

39
Q

Following portal hypertension, what is the next most common cause of varices

A

Hepatic schistosomiasis

40
Q

What are the treatments used to treat esophageal varices

A

Splanchnic vasoconstriction
Sclerotherapy (injection of thrombin agents)
Ballon tamponade
Varicella ligation

41
Q

What is the main risk factor that needs to be addressed in patients with esophageal varices

A

The size and past history of bleeding

  • Large tend to bleed and recurrent bleeding
  • Small tend to not bleed
42
Q

What is the typical patient group at risk for Barrett esophagus

A

White males between 40 to 60

43
Q

What is the greatest risk associated with Barrett esophagus

A

Adenocarcinoma

44
Q

The presence of dysplasia in Barrett esophagus is correlated with which things

A
  • prolonged symptoms
  • longer segment length
  • increased patient age
  • Caucasian race
45
Q

What is the change seen in Barrett esophagus

A

-squamous esophageal epithelium replaced with goblet cells

46
Q

What are the histological stain findings with Barrett esophagus

A

Mucous vacuole that stain blue with an H and E stain, leading to the shape of a wine goblet to the remaining cytoplasm

47
Q

What is the most common esophageal tumor in the US and worldwide

A

Adenocarcinoma

48
Q

What is the most common esophageal tumor in the world

A

Squamous cell carcinoma

49
Q

What is the majority of benign tumors of the esophagus

A

Mesenchymal, so include smooth muscle cells

50
Q

Which risk factors increase the risk of adenocarcinoma

A

Barrett esophagus
Tabacco use
Radiation
Lack of fresh fruits and vegetables

51
Q

How does H pylori actually decrease the risk of adenocarcinoma

A

Causes gastric atrophy and the subsequent decrease in acid leads to decreased risk of Barrett esophagus

52
Q

What is the patient group most commonly affected by adenocarcinoma

A

White Caucasian males

53
Q

What are the mutations assocaited in the early transition from Barrett esophagus to adenocarcinoma

A
  • TP53

- CDK2NA

54
Q

What are the mutations assocaited in the late transition from Barrett esophagus to adenocarcinoma

A 
EGFR
ERBB2
MET
Cyclin D1
Cyclin E
55
Q

The adenocarcinomas that from from Barrett esophagus typically produce what

A

Forms glands and secrete mucin

56
Q

What are the clinal presentations of esophageal adenocarcinomas

A 
Pain/difficulty swallowing
Progressive weight loss
Hematemesis
Chest pain
Vomiting
57
Q

Where doe the tumor general spread in adenocarcinomas of the esophagus

A

Submucosa lymphatic Vessels

58
Q

What is the population group that is affected by squamous cell carcinoma of the esophagus

A

African amaerican (8x more likely) Males (4x) older than 45 years

59
Q

What are the risk factors for developing squamous cell carcinoma

A
  • Alcohol and tobacco
  • achalasia
  • tylosis
  • Plummer-Vinson syndrome
  • Lacking fruits and vegetables
  • Very hot beverages*
60
Q

Which cancer of the esophagus is increased via radiation and when does it typically present

A

-Squamous cell carcinoma, occurring 5 to 10 years after exposure

61
Q

Which regions dent to have a higher risk for developing squamous cell carcinomas

A
  • Rural and underdeveloped areas
  • Western Kenya
  • Iran, China, Hong Kong
62
Q

Where is Africa is there a higher rate of squamous cell carcinoma and what is the cause

A

Western Kenya, due to consumption of mursik, which contains acetalaldehyde

63
Q

What is the majority of squamous cell carcinomas of the esophagus due to in the US and western countries

A

Alcohol and tobacco use (synergistic)

64
Q

What are the mutations associated with increased risk of squamous cell carcinoma of the esophagus

A

-SOX2
-Cyclin D1
TP53
-E Cadherin
-NOTCH1

65
Q

Where in the esophagus do adenocarcinomas occur

A

Distal 1/3

66
Q

Where in the esophagus do squamous cell carcinomas occur

A

Middle 1/3

67
Q

How do squamous cell carcinomas begin

A

As squamous dysplasia (aka intraepithelial neoplasm/carcinoma in situ)

68
Q

What are some locations of complications of squamous cell carcinomas and their spreading in the cavity

A
  • Respiratory tree leading to pneumonia
  • aorta leading to exsanguination
  • Mediastinum and pericardium
69
Q

What is the location of Squamous cell carcinoma of the esophagus if it spread to the cervical lymph nodes

A

Upper 1/3

70
Q

What is the location of Squamous cell carcinoma of the esophagus if it spread to the paratracheal lymph nodes

A

Middle 1/3

71
Q

What is the location of Squamous cell carcinoma of the esophagus if it spread to the gastric and celiac lymph nodes

A

Lower 1/3

72
Q

What are the clinical presentations of squamous cell carcinoma of the esophagus

A 
Dysphagia
Odynophagia (pain on swallowing)
Obstruction 
Change in eating from solid to liquid 
Weight loss
Iron loss
73
Q

What is commonly a first symptom of squamous cell carcinoma

A

Aspiration of food via the tracheoesophageal fistula

74
Q

What is associated with the poorer prognosis in esophageal squamous cell carcinoma

A

LN metastasis

Robbins Pathology GI (Chptr 16,17,18,19) (32 decks)

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